Abstract 2720: “Stop telling us what to do and tell us how to do it”: A Qualitative Meta-Analysis of Skill Development in Heart Failure Self-Care
Background: Heart failure (HF) self-care requires both knowledge and skill, but little attention has been given to identifying how to improve skill in HF self-care.
Methods: We assessed what self-care skills are needed and how patients develop these skills using qualitative descriptive meta-analysis techniques. Transcripts from three mixed methods studies (n=85) were re-examined and translated to yield themes about the process of developing skill in HF self-care, defined as behaviors that maintain physiologic stability (maintenance) and the response to symptoms when they occur (management).
Results: The sample was 63.5% Caucasian and 58.8% male, mean age of 55.69 years (± 13.42). Most (52.9%) were NYHA class III. Narrative accounts of HF self-care revealed that the most challenging self-care maintenance skills were diet, and exercise. The management skill that was most challenging was how to titrate diuretics in response to a weight gain. Skills developed over time through coaching by trusted resources (mostly friends or family with HF). Tactical skills (“how to” prepare low salt meals; “how to” start an exercise plan) were helped by role-playing. Situational skills (“what to do when”) most essential for self-care management were evident in descriptions of how they planned for special occasions. For example, significant others helped patients think through how to manage symptoms of fluid retention while traveling. Few patients saw traditional healthcare providers as resources they could call upon to aid them in developing tactical and situational skills. Patient education was not identified as a factor associated with the development of HF self-care skill. Rather, they struggled to operationalize the self-care knowledge they attained.
Conclusion: Skill in HF self-care evolves over time, with experience and practice, as patients learned how to make self-care practices fit into their daily lives, but coaching by nurses may help patients develop the skill needed to master self-care skills. Research testing coaching interventions that target skill building tactics such as role-playing in specific situations is needed.